MEDICARE: MADELINE KUMMETH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	033426	AZ

General Provider Information

NPI Number	:	1841058559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE KUMMETH

Provider Business Mailing Address
First Line	:	410 E CREOSOTE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7204
Country	:	US
Telephone Number	:	623-297-8651
Fax Number	:

Provider Business Practice Location Address
First Line	:	5017 E WASHINGTON ST STE 107A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2033
Country	:	US
Telephone Number	:	602-277-1073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ MADELINE KUMMETH ” Practice Location

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